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Acne vulgaris (commonly called acne) is a skin disease caused by changes in the pilosebaceous units (skin structures consisting of a hair follicle and its associated sebaceous gland). Severe acne is inflammatory, but acne can also manifest in noninflammatory forms.[1] Acne lesions are commonly referred to as pimples, blemishes, spots, zits, or acne.
Acne is most common during adolescence, affecting more than 85% of teenagers, and frequently continues into adulthood. The cause in adolescence is generally an increase in male sex hormones, which people of all genders accrue during puberty. [2] For most people, acne diminishes over time and tends to disappear—or at the very least decrease—after one reaches his or her early twenties. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will continue to suffer well into their thirties, forties and beyond.[3]
The face and upper neck are the most commonly affected, but the chest, back and shoulders may have acne as well. The upper arms can also have acne, but lesions found there are often keratosis pilaris, not acne. Typical acne lesions are comedones, inflammatory papules, pustules and nodules. Some of the large nodules were previously called “cysts” and the term nodulocystic has been used to describe severe cases of inflammatory acne. [4]
Aside from scarring, its main effects are psychological, such as reduced self-esteem[5] and, according to at least one study, depression or suicide.[6] Acne usually appears during adolescence, when people already tend to be most socially insecure. Early and aggressive treatment is therefore advocated by some to lessen the overall impact to individuals.[5]
The term acne comes from a corruption of the Greek ??µ? (acne in the sense of a skin eruption) in the writings of Aëtius Amidenus. Used by itself, the term “acne” refers to the presence of pustules and papules.[7] The most common form of acne is known as “acne vulgaris”, meaning “common acne”. Many teenagers get this type of acne. Use of the term “acne vulgaris” implies the presence of comedones.[8]
The term “acne rosacea” is a synonym for rosacea.[9] Chloracne is associated with chlorine toxicity.
Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedo (blackhead) or closed comedo (whitehead). Whiteheads are the direct result of skin pores becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions the naturally occurring largely commensal bacteria Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedo, which results in redness and may result in scarring or hyperpigmentation.[10]
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